In-patient wards checklist and Quality Indicators for NABH accreditation

In-patient wards are the place where most of the patient care activities happens. While preparing for NABH, wards requires high amount of attention as a large number of NABH standards applies to it. This post identifies such requirements and can be used as a checklist by hospitals preparing for NABH accreditation. The checklist, being general in nature, must be reviewed for its suitability to individual hospital, before use.

The checklist is relevant for an inter-mediate care ward. There are additional requirements for specialized wards such as ICU, emergency etc. which will be listed under separate heading in upcoming posts. Readers are requested to subscribe to the blog through email for getting regular updates on posts.

Before going through this checklist please also go through ‘Infrastructure checklist for NABH accreditation’

A. Physical facilities related requirements:

1. Sufficient space for carrying out patient care activities with adequate circulation space
2. Facility should be safe from any physical injury chances (non-slippery floor, safe electrical fittings, no accidental spots etc.)
3. Inter-bed distance to be maintained at around 6 feet
4. Hand washing area easily accessible to healthcare staff
5. Accessibility of fire-fighting equipment
6. Crash cart placed at a location from where it could be immediately accessed when required
7. Patient’s washroom should have safety arrangements (anti-skid mats, emergency call button, grab bars, disable friendliness, door opening outside, latch type locking which can be opened from outside)
8. Adequate privacy arrangement for patient (especially applicable in multi-bed wards)
9. Availability of all necessary patient care equipment
10. Bio-medical waste bins as per BMW rules
11. Separate or segregated storage area for clean and dirty supplies
12. Emergency exit route and display

 B. Staffing related requirements

1. Categories of nurses required to be identified (depending upon the type of ward, for eg. Paediatric ward must have nurses trained in paediatric care)
2. Nurse: patient ratio to be defined for the ward in each shift
3. Duty roster to serve as an evidence of nurse patient ratio
4. Duty doctor should be available round the clock (physical or on call)
5. Other support staff as required

 C. Ward management related requirements

1. Linen on patients’ beds to be changed daily (or as defined by hospital’s policy)
2. Periodic cleaning of mattresses, pillow and other bed items
3. Temperature of refrigerator in which medicines are stored should be monitored and recorded, at-least once in each shift
4. Crash cart should have all life-saving drugs and equipment. It should be replenished whenever used
5. All emergency medicines should be available as per defined quantity
6. Mechanism of replenishing emergency medicines to be followed
7. If medicines are stored in wards, look alike, sound alike medicines to be stored separately (or as per hospital’s policy)
8. High risk medicines to be identified and stored separately
9. Multi-use open vials to have labels of date of opening and date of expiry
10. If NDPS are temporarily stored, it should be under lock and key. NDPS regulations to be followed. (Check this post on 'all legal documents required by a hospital')
11. Proper identification of patient before carrying out any patient care activity
12. Reporting of adverse patient events
13. List of hazardous materials in the ward to be identified and MSDS sheet for them should be available
14. Bio-medical waste should be segregated as per regulation
15. All areas of wards, including washrooms should be maintained neat and tidy
16. Clean supplies and dirty used items should be stored separately
17. Maintenance of medical records as per hospital’s policy
18. Security and confidentiality of medical records to be maintained as per hospital’s policy
19. Maintenance of necessary registers (admission-discharge, stock, laundry, adverse incident register etc.)

D. Staff awareness related requirements: Staff of the ward (nurses and doctors) should receive training and be aware on a large number of topics. The important ones from accreditation point of view are;

1. Components and time-frame for initial assessment of admitted patients
2. Uniform care policy and patient care processes that falls under it
3. Patients’ rights
4. Dealing with HIV +ve patients and maintaining confidentiality
5. Provision of basic cardiac life support
6. Code blue policy and procedure
7. Other emergency codes (such as code pink, code red, code yellow etc.)
8. Identification and care of vulnerable patients
9. Care of surgical patient/paediatric patients/obstetric patients (as per ward speciality)
10. Proper identification of patients
11. Safe medication practices (things to check before administration, monitoring, verbal orders, administering high risk medicines etc.)
12. Safe blood transfusion practices
13. Policy and procedure of patient’s restraint
14. Pain management policy and protocol
15. Standard precautions for infection control (hand hygiene, use of PPE etc.)
16. Safe injection practices
17. Patient safety incidents, its types and reporting (such as near miss, sentinel, adverse drug reaction etc.)
18. Emergency evacuation plan
19. Their role during any disastrous situation
20. Basic fire safety measures

E. Quality Indicators for wards: These QIs can be calculated in each ward and then combined for hospital wide QI

1. Average time for initial assessment of admitted patient and % outliers 
2. Incidence of medication errors
3. Percentage of admissions with adverse drug reactions
4. Percentage of patients receiving high risk medicines and developing adverse drug reaction
5. Percentage of transfusion reaction
6. Percentage of near miss events
7. Incidence of patient falls
8. Incidence of bed sores after admissions
9. Incidence of patient rights violations
10. Incidence of needle stick injuries
11. Incidence of missing medical records
12. Percentage of non-compliance observed related to infection control practices
13. Patient satisfaction rate of the ward (Checout a sample form)
14. Time taken for discharge
15. Average nurse patient ratio in each shift
16. Percentage of current medical records that are incomplete as per hospital’s policy

Besides these there are requirements related to clinical care and nursing care also which are assessed in wards. These will be listed separately in upcoming posts. 

Note: There could be additional requirements depending upon type of hospital and its existing situation.

All checklists

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